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' Ratehykin: <br />� � �/�hh -AN JOAUUIN <br />��ffOp <br />COUNT`r 1='UBLIC HEALTH <br />l f�Vlc_ epmt #5104 <br />- <br />a<It� #f I <br />Copy 1 = <br />01 of 01 COMPt_AINT <br />INVESTIGATION REPORT <br />.vac,41 <br />COMPLAINT <br /># = C0005944 <br />Progri-irn/Elerne nt - 4200 <br />Taken by : 9051 <br />MARY OSULLIVAN Date: 04/23/96 <br />Assigned to <br />Date: 04/23/96 <br />Hard copy Printed: 04/23/96 _ <br />E* o�c✓F ,?,4 <br />Facility <br />Nar -�'_"--- Fac ID:--- <br />/5 <br />- <br />BILL to inventoried FACILITY: <br />Location= <br />_..... __. ._ _� <br />= _ <br />(Must have FACILITY ID# ) <br />Complainant _..... s.lw.,• �c�us <br />Addr ess = -- ._.._...-........ <br />FACILITY LOCATION/Property Info - <br />DBA or Name: <br />Address <br />City: <br />Phone: <br />Home Phone: :3 C- 9 — G / 'rS- <br />Work Phone: <br />Loc Code <br />BOS Dist <br />APN # <br />BILLING RESPONSIBLE PARTY o OWNER nfo - <br />Name : Home <br />P' hor1e <br />> o.c. n�e.._.....�ws..k T� c. e e _._..____..___.__ ____.__ _._ . <br />Address: ,` a..l. ..,....4r'.x Q.1 . W � e <br />City: Mv►.-faJ��e ,cit ��o&,q <br />Nature of Complaint: <br />WOODBRIDGE RD. WEST SIDE OF 99 . WI TH A z�- 1 (:) i0 Eak-1ki11LER O <br />SEPTIC HOOKUP A PIT 30-4OFT OF HIS WELL. GARBAGE AND �JUN� l <br />tv" f�u"rt,v"� <br />COMPLAINT Info - <br />COMPLAINT MODE: <br />A -Agency Referral B -BD OF Supervisors/City Ccouncil C -Counter M-Mail/Correspondence <br />0-Other\EH Unit P -Phone <br />l <br />COMPLAINT STATUS: C <br />cF*eld Abated 02 -Office Abated 03 -NAI Sent 04 -Notice to Abate Issued 05 -Enforce ACT Initiated <br />ansfer to Premise File 07 -Refer to Other Agency 08 -Not Valid 09 -Foodborne Illness <br />Circle appropriate Unit # if complaint in another PROGRAM jurisdiction, Have Complaint Record and P/E updated <br />Forwarded to UNIT: I II III IV for Investigation <br />